No benefit of hydroxychloroquine for inflammatory, erosive hand osteoarthritis
medwireNews: The OA TREAT investigators have demonstrated that hydroxychloroquine does not improve pain, function, or radiographic progression in patients with inflammatory and erosive hand osteoarthritis (OA).
The investigator-initiated trial was “the first large randomized placebo-controlled trial focusing on erosive hand OA,” and was developed based on promising findings from “studies of hydroxychloroquine in the 1990s and its off-label use seen in clinical practice,” said lead author Claudia Kedor (Charité–Universitätsmedizin Berlin, Germany) at the EULAR 2020 E-Congress.
She told delegates that pain and hand function improved to a comparable degree among the 75 patients who were randomly assigned to receive hydroxychloroquine 200–400 mg/day alongside stable standard therapy and the 78 given add-on placebo.
Specifically, average pain scores measured using the AUSCAN index improved from 31.1 points at baseline to 26.7 points at 1 year in the hydroxychloroquine arm, and from 30.7 to 26.5 points in the placebo group. Average AUSCAN function scores improved from 58.5 to 48.1 points and from 57.8 to 51.3 points, respectively.
There was also no significant difference in radiographic progression among patients treated with hydroxychloroquine versus placebo, with comparable average modified Kallman scores in the two groups and “similar results” with other measures of radiographic progression, said Kedor.
There was, however, a significantly lower average erythrocyte sedimentation rate among patients treated with hydroxychloroquine versus placebo (8.2 vs 11.7 mm/h), whereas the average duration of morning stiffness was significantly higher in the hydroxychloroquine group (30.2 vs 16.3 minutes).
Overall, the trial results suggest that hydroxychloroquine is “no more effective than placebo” for the treatment of inflammatory and erosive hand OA, said Kedor, noting that the safety findings were “consistent with the known [safety] profile of hydroxychloroquine.”
The OA TREAT results support those from the HERO trial, which demonstrated no benefit of hydroxychloroquine for patients with symptomatic radiographic hand OA.
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